比较不同方法改善中国绝经后糖尿病女性骨折风险评估的效果：一项病例对照研究。

Comparison of methods to improve fracture risk assessment in chinese diabetic postmenopausal women: a case-control study.

机构信息

Health Management Center; National Clinical Research Center for Metabolic Diseases; Department of Metabolism and Endocrinology; Hunan Provincial Key Laboratory for Metabolic Bone Diseases, the Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.

Department of Metabolism and Endocrinology, the affiliated Zhuzhou Hospital of Xiangya School of Medicine of Central South University, 116 Changjiang South Road, Zhuzhou, 412007, Hunan, China.

出版信息

Endocrine. 2021 Jul;73(1):209-216. doi: 10.1007/s12020-021-02724-y. Epub 2021 May 1.

DOI:10.1007/s12020-021-02724-y

PMID:33932202

Abstract

PURPOSE

This study evaluated the predictive power of adjusted FRAX and standard FRAX models based on the actual prevalence of osteoporosis in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China.

METHODS

We recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients.

RESULTS

T2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients.

CONCLUSIONS

Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.

摘要

目的

本研究评估了基于 2 型糖尿病（T2DM）绝经后女性实际骨质疏松患病率调整后的 FRAX 和标准 FRAX 模型的预测能力，并探讨了在中国糖尿病绝经后妇女中更好地预测骨折风险的最佳策略。

方法

我们从社区医疗中心招募了 434 名患者，其中 217 名患有 T2DM，217 名无 T2DM（非 T2DM）。所有参与者完成了详细描述其特征和危险因素的自我报告问卷。评估了骨密度（BMD）和脊柱 X 光片。中国 FRAX 模型计算了所有评分。受试者工作特征曲线（ROC-AUC）评估了 T2DM 患者预测 10 年主要（MOF）和髋部（OHF）骨质疏松性骨折风险的敏感性、特异性和准确性。

结果

T2DM 患者的 BMD 较高，但平均 FRAX 值较低。未经调整的 FRAX ROC-AUC 为 0.774，显著小于 0.5 个单位股骨颈 T 评分调整的 FRAX（0.800；p=0.004）。类风湿关节炎（RA；AUC=0.810，p=0.033）和 T 评分（AUC=0.816，p=0.002）调整显著改善了 T2DM 患者的骨折预测。